Benida's
Registration

Name of child_________________________Age______M / F
..............................................please print
Parent or Legal Guardian______________________________ 

Address__________________________________________
 
Phone___________________cell_______________________

Email_____________________________________________

Emergency ______________________phone______________

Amount enclosed $____________

Release:

Benida's Clay • Art Workshop, Benida Solow and Ron Grant are not responsible for any damages to or loss of personal possessions or any bodily injuries that may incurred during the workshop. There are no make ups for missed classes

Signed____________________________Date____________  

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